Tips for tolerating your stent after your urologic procedure

2529 Glenn Hendren Drive, Suite 202 Liberty MO 64068 816.781.8400

2700 Clay Edwards Drive, Suite 300 North Kansas City, MO 64116 816.842.0171

Tips for tolerating your ureteral stent after your urologic procedure

During your procedure, your urologist placed a stent into your ureter (the tube that connects your kidney to your bladder). This ureteral stent functions much like a tiny straw that has as small coil in the kidney and in the bladder to help hold it in place and to keep your ureter open until the healing process is complete. If the stent is removed prior to the resolution of swelling, you may experience significant discomfort. This pain is very similar to the pain experienced with a kidney or ureteral stone. Therefore, we urge you to leave the stent in for the prescribed amount of time. Please read the following tips for tolerating your stent after your procedure:

To improve the tolerability of the stent, several medications are available. Consider taking the Pyridium (phenazopyridine) which may have been prescribed. This medication may improve the tolerability of your stent by decreasing burning urination and soothing the bladder. Please be aware that this medication causes your urine to be a deep amber or orange color and can stain your undergarments.

If Pyridium isn't controlling your discomfort, consider taking Naprosyn (naproxen) or over the counter ibuprofen if you do not have a history of kidney disease, peptic ulcer disease, or stomach or gastric ulcers. This medication is very effective in treating urinary pain and discomfort. It can treat bladder pain and discomfort associated with your stent as well as decrease the swelling associated with your procedure.

If the above two medications are not effectively controlling your pain, or you have the sensation of bladder spasms, consider taking Enablex (darifenacin).This is a medication that helps relieve bladder cramps and spasms often experienced with a ureteral stent.

Prior to removing your urinary stent Prior to removing your urinary stent, several things can be done to improve your comfort during and after the removal process. First, we recommend taking 500 mg of Naprosyn (naproxen) approximately 90 minutes prior to removing the stent. Second, consider taking one or two of your narcotic pain medications (Vicodin,etc) at the same time. Third, limit the amount of fluid you consume for the first six hours after stent removal. Please do not dehydrate yourself, but refrain from consuming unusually large amounts of fluid, especially if you start to experience pain in your back.

How to remove your stent Consider removing the stent in the shower. Simply remove the tape holding the string to your skin and gently pull on the string until the stent has been removed completely. The string and the stent measure approximately 24 inches, so keep pulling!

When to remove your stent We urge you to leave the stent in for the prescribed amount of time. If you're concerned that you may experience significant pain after your stent removal, you may keep the stent in place for a few extra days. For example, if you are instructed to remove your stent over a holiday, you may choose to remove the stent a day or two after the holiday to ensure you don't have severe pain requiring you to go to the emergency department during the holiday.

I'm experiencing severe pain 30 minutes or more after the stent removal, what now? If pain is experienced during this process, it usually occurs 30 minutes to 4 hours after the stent removal. It is unusual to experience any significant pain during the process of removing the stent. The cause of the pain is swelling in the tube connecting the kidney to the bladder. Taking your pain medications may be required to alleviate this pain, which may be severe in nature. The pain usually resolves in a few hours.

We greatly appreciate working with you and would encourage you to call with any questions or concerns you may have. Our nurses are very knowledgeable and can answer your questions. Please refer to the back side of this handout for a list of frequently asked questions. You may find the answers helpful.

Remove your stent on ______________________

Follow up with: Frank Albani, MD Kent Haggard, MD

with a KUB (x-ray) in ______days for Diagnosis- Kidney Stone

Justin Albani, MD James Magera, MD

Signature: ____________________________________Date____________________

Frequently Asked Questions about Ureteral Stents

Q Is it normal to have discomfort present? A Yes. In fact, certain movements may increase discomfort. Examples include: frequent bending and

increased activity.

Q Is it normal to feel like I have to urinate more often? A Yes, this should resolve after the stent is removed. Also, some patients experience urgency of urination

with incontinence. This will also resolve after the removal of the stent. If incontinence is a constant drip, the stent may have migrated. Call our office for further instructions if constant dripping incontinence is experienced.

Q Is it normal to feel pain or pressure before and/or during urination? A Yes, some patients have significant pain in the back during urination because the stent allows urine to

flow back toward the kidney. Others may experience pain in the bladder because the stent may cause a bladder cramp during or at the end of urination.

Q Is it normal to have blood in my urine and what if it is not present all the time? A Yes. The stent will cause some irritation to tissue, it may be present while you have the stent and after

you remove the stent. The blood may be a light red or darker at times. Don't be alarmed if the blood resolves and then returns. This is typical for most patients.

Q When should the stent be removed? A Please carefully follow the doctors instructions regarding the length of time your stent should remain in

your body. If you where not provided with this information upon discharge, please contact are office so a nurse can consult with the doctor. If the stent is removed too early, complications may arise including but not limited to severe kidney infection and severe pain. If the stent is left in for more than 12 weeks, complications may arise including but not limited to severe kidney infection and development of new stones on the stent.

Q How do I remove my stent? A If your stent has a string attached to it, remove the tape and gently pull on the string. The stent will

easily come out. Keep in mind that the length of the stent plus the string is 24 inches long! If your stent does not have a string, it must be removed by the Urologist in the office or at the hospital (typically as an outpatient). Please contact our office to schedule a follow up.

Q Is it painful to remove the stent by pulling on the string? A No. Most patients report only minor discomfort or no discomfort at all. Most patients report relief.

Q Is it normal to have pain 30 minutes or more after I remove the stent? A Yes. But many patients won't experience any pain. However, for a few patients, pain may be severe not

during, but after the removal of the stent. If pain is not experienced in the first several hours after stent removal, it is unlikely to be experienced at all.

Q Why do some people experience pain 30 minutes or more after stent removal? A Most often, the cause of pain is mucus or blood clot blocking the flow of urine out of the kidney which

produces pain. The pain will usually resolve spontaneously in a few minutes to a few hours.

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